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Billing and Reporting Title V MCH FEE, PHC, BCCC Deborah Lewis, Program Specialist Billing and Reporting CHS Contract Management Home Page http://www.dshs.state.tx.us/chscontracts/ default.shtm Click on Forms All report forms are available Contractor Vouchers and Reporting

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billing and reporting

Billing and Reporting

Title V MCH FEE, PHC, BCCC

Deborah Lewis, Program Specialist

billing and reporting2
Billing and Reporting

CHS Contract Management Home Page

  • http://www.dshs.state.tx.us/chscontracts/ default.shtm
  • Click on Forms
  • All report forms are available
  • Contractor Vouchers and Reporting
title v mch fee for service
Title V MCH Fee for Service
  • Accessing Procedures Manual
  • Forms and Instructions
  • Submitting Reports
  • Report Approvals
  • Common Questions
  • Common Errors
  • Contacts
title v mch fee for service4
Title V MCH Fee for Service

Accessing Policy & Procedure Manual

http://www.dshs.state.tx.us/mch/fee/policy.shtm

Section 2 – Performance Management

Billing & Reporting

title v mch fee for service5
Title V MCH Fee for Service

Forms and Instructions

  • Monthly Reimbursement Request (MRR)
  • Identifying information found on cover pages 1 & 2 of the contract
title v mch fee for service6
Title V MCH Fee for Service

Identifying Information – Example 1

  • Contract term runs September – August
  • Payee Name, Contractor Name, Address, and Payee Vendor ID # must agree
  • Payee Vendor ID # is 14 digits
  • DSHS Funding is already completed on the downloaded Excel File
  • Purchase order # is 10 characters
title v mch fee for service7
Title V MCH Fee for Service

Identifying Information (continued)

  • DSHS Document # is 10 digits based on Tax ID and may have an alpha character
  • Year – Attachment # is 4 digit year – 2 digit attachment #
  • As contract amendments are fully executed, a 1 up alpha character will be added to the attachment #
  • Period cover by this report is MO/YR
  • Prepared By and Phone number should be completed on each page
  • Processed by line should be left blank
title v mch fee for service8
Title V MCH Fee for Service

Review Components of 185

  • Age group 1-21
  • Watch for Case Management
  • Watch for lab billing included with Prenatal visits
  • Make sure billing is in accordance with Service Delivery Plans (SDP)
title v mch fee for service9
Title V MCH Fee for Service

Review Components of 186

  • Infants 0 – 11 months
  • Women over 21
  • Watch for Case Management
  • Watch for lab billing included with Prenatal visits
  • Make sure billing is in accordance with Service Delivery Plans (SDP)
title v mch fee for service10
Title V MCH Fee for Service

Special Services Report (SSR)

  • Billing for Genetic Services
  • Page may be eliminated in FY 07
title v mch fee for service11
Title V MCH Fee for Service

Review Monthly Activity Report (MAR)

  • Counts start over in September for each service
  • Each person should be counted one time per service per year
  • Counts on the MAR should coincide with age group billing
title v mch fee for service12
Title V MCH Fee for Service

Submitting Monthly Reports

  • Table is in the Manual Section 2 Page 1
  • Due 30 days following the end of the month
  • MRR emailed to the Central Processing Unit (CPU) at invoices@dshs.state.tx.us, or faxed to 512-458-7442
  • MRR, 185, 186, SSR (if applicable), MAR faxed to 512-458-7235
  • Please submit all pages simultaneously
title v mch fee for service13
Title V MCH Fee for Service

My Spreadsheet

  • Shows report approval date
  • Tracks all expenditures
  • Monitors expenditure levels
  • Monitors 185 & 186 for 25% spending on ages 1-21
  • Tracks performance measures
title v mch fee for service14
Title V MCH Fee for Service

Common Questions

Q. Can co-pays be charged?

A. Yes up to 25% of the reimbursable amount

Q. Can the 25% requirement be annualized?

A. Yes the requirement is on a state wide basis

Q. Should co-pays for flu vaccine be reported as program income

A. No co-pays for flu vaccine should not be reported as program income because it is not a reimbursable expense

title v mch fee for service15
Title V MCH Fee for Service

Common Errors

  • Incorrect form submission
  • Missing report pages
  • Pages indicate different periods covered
  • Identifying information incorrect
title v mch fee for service16
Title V MCH Fee for Service

Common Errors (continued)

  • Billing for labs inappropriately
  • Billing for services outside the SDP
  • Unduplicated client counts inconsistent with billing
  • Counts not started over in September
title v mch fee for service17
Title V MCH Fee for Service

Making Corrections

  • If the correction is requested, only submit affected pages
  • If the correction is discovered, correct the next monthly billing
title v mch fee for service18
Title V MCH Fee for Service

Payment Complications

  • Purchase order adjustments for program code
  • Purchase order adjustments for funding source
title v mch fee for service19
Title V MCH Fee for Service

Annual DSHS Form GC-10 (270)

  • PDF File
  • http://www.dshs.state.tx.us/grants/forms.shtm
  • Revisions still need to be addressed
  • This form should be used in the interim
title v mch fee for service20
Title V MCH Fee for Service

Instructions for the 270 Report

  • In box 1b place X in the final box
  • In box 4 enter Vendor ID
  • In box 8 enter contract term
  • In box 9 enter name and address
  • In box 13 sign, date, type, or print name, title and phone number
title v mch fee for service21
Title V MCH Fee for Service

Instructions for 270 (continued)

  • Total Reimbursable Services – after 2.5% reduction not to exceed contract amount
  • Less Program Income (PI)
  • Expected Total Payment Amount
  • Total PI Available is the same as program income
  • PI Expended usually is the same as PI available
  • PI to be refunded is usually zero
  • Disregard the second page for cash on hand
title v mch fee for service22
Title V MCH Fee for Service

Annual Report Submission

  • Table is in the Manual Section 2 Page 2
  • Due no later than 90 days after the end of the contract term
  • Original signatures required
  • Mail two separately to: DSHS

CPU mail code 1940 and CMB mail code 1914

1100 W. 49th St Austin, TX 78756

title v mch fee for service23
Title V MCH Fee for Service

Contacts

  • Deborah Lewis 512-458-7781 Program review questions
  • Grisilda Porter 512-458-7111 ext 2940 Payment status questions
  • Millicent Wilkins 512-458-7111 ext 2285 Vendor ID questions
  • Gina Baber 512-458-7111ext 6445 Contract Amendment questions
  • Travis Duke 512-458-7111 ext 3157 Policy questions
title v mch fee for service24
Title V MCH Fee for Service

Questions & Answers

  • Making the pieces fit
primary health care phc
Primary Health Care (PHC)
  • Accessing Procedures Manual
  • Forms and Instructions
  • Submitting Reports
  • Report Approvals
  • Common Errors
  • Contacts
primary health care phc26
Primary Health Care (PHC)

Accessing Policy & Procedure Manual

http://www.dshs.state.tx.us/phc/pandp.shtm

Section 2 – Performance Management

Billing & Reporting

primary health care phc27
Primary Health Care (PHC)

CHS Contract Management Home Page

  • http://www.dshs.state.tx.us/chscontracts/ default.shtm
  • Click on Forms
  • Click on Primary Health Care to access all PHC forms
  • Click on Contractor Vouchers and Reporting for report submission instructions
primary health care phc28
Primary Health Care (PHC)

Forms and Instructions

  • Monthly Reimbursement Request (MRR)
  • Identifying information found on cover pages 1 & 2 of the contract
  • Approved budget found on attachment page 4
primary health care phc29
Primary Health Care (PHC)

Identifying Information – Example 1

  • Contract term runs September – August
  • Payee Name, Contractor Name, Address, and Payee Vendor ID # must agree
  • Payee Vendor ID # is 14 digits
  • DSHS Funding should be CHS/PHC
  • Purchase order # is 10 characters
primary health care phc30
Primary Health Care (PHC)

Identifying Information (continued)

  • DSHS Document # is 10 digits based on Tax ID and may have an alpha character
  • Year – Attachment # is 4 digit year – 2 digit attachment #
  • As contract amendments are fully executed, a 1 up alpha character will be added to the attachment #
  • Period cover by this report is MO/YR
  • Prepared By and Phone number should be completed on each page
  • Processed by line should be left blank
primary health care phc31
Primary Health Care (PHC)

Approved Budget – Example 2

  • Found in the contract attachment Section III page 4 (usually the last page)
  • The total goes in the TDH Funding block above the word Salaries
  • MRR amounts should match quarterly FSR amounts
  • Budget variances must stay within the 10% budget variance rule
primary health care phc32
Primary Health Care (PHC)

Contract Amendments Impact the MRR

  • Changes occur when contract is fully executed
  • Attachment always changes with 1 up alpha character
  • TDH Funding block changes if applicable
  • Approved Budget amount changes if applicable
primary health care phc33
Primary Health Care (PHC)

Types of PHC Clients

  • Full Service – only eligible for PHC
  • Supplemental Service – eligible for PHC but as a supplemental funding
  • Presumptive Eligibility – Presumed eligible for PHC for up to 90 days (only used if there is an immediate medical need prior to the completion of the eligibility process)
primary health care phc34
Primary Health Care (PHC)

Review Monthly PHC 200

  • Question 1 refers to monthly eligibility screening
  • Questions 2 & 3 refer to monthly enrollment & re-certification
  • The sum of 2 + 3 should always be less than, or equal to the sum of 1b + 1C
primary health care phc35
Primary Health Care (PHC)

Review Monthly PHC 200 (continued)

  • Question 4 refers to the number of PE’s on PHC during the month
  • Question 5 is the unduplicated YTD count
  • Question 6 is the number of visits each month
primary health care phc36
Primary Health Care (PHC)

Submitting Monthly Reports

  • Table is in the Manual Section 2 Page 1
  • Due 30 days following the end of the month
  • MRR emailed to the Central Processing Unit (CPU) at invoices@dshs.state.tx.us, or faxed to 512-458-7442
  • MRR and PHC 200 faxed to 512-458-7235
  • Please submit all pages simultaneously
  • Only submit revised pages when corrections are requested
primary health care phc37
Primary Health Care (PHC)

My Spreadsheet

  • Shows report approval date
  • Tracks all expenditures & quarterly balances
  • Monitors expenditure levels
  • Tracks performance measures
  • Tracks quarterly & annual report submission
primary health care phc38
Primary Health Care (PHC)

Common Errors on Monthly Reports

  • Incorrect form submission
  • Missing pages
  • Identifying information incorrect
  • Budget & TDH Funding incorrect
  • Cumulative amounts incorrect
  • 1b + 1c less than 2 + 3
primary health care phc39
Primary Health Care (PHC)

Common Errors on Monthly Reports (continued)

  • Incomplete forms, or blanks
  • Incorrect totals on PHC 200
  • Decrease in Year-to-Date totals
  • Counting clients not specified in the SDP
  • Dates don’t coincide
primary health care phc40
Primary Health Care (PHC)

Making corrections

  • If the correction is requested, only submit affected pages
  • If the correction is discovered, correct the next monthly billing
primary health care phc41
Primary Health Care (PHC)

Quarterly PHC 301

  • List the YTD cost of PHC services
  • List the YTD number of services provided
  • Calculate the cost per unit of Service (cost divided by number)
primary health care phc42
Primary Health Care (PHC)

Submitting the Quarterly PHC 301

  • Table is in the Manual Section 2 page 2
  • Due via fax to CMB at 512-458-7532
  • Due Dec 31, Mar 31, June 30, & Sept 30
primary health care phc43
Primary Health Care (PHC)

Common PHC 301 Errors

  • YTD cost of services are not YTD
  • Number of services should not be an unduplicated count
  • Incorrect unit cost calculations
primary health care phc44
Primary Health Care (PHC)

Quarterly DSHS Form GC-4a (269a)

  • Financial Status Report
  • Excel file
  • http://www.dshs.state. tx.us/grants/forms.shtm
  • Revisions will be minimal
primary health care phc45
Primary Health Care (PHC)

Instructions for the Quarterly FSR 269a

  • Complete Identifying information at the top
  • Approved budget should match the most current fully executed contract
  • DSHS share should never exceed the contract amount
  • Reimbursements should show the amount you expect to receive for the quarter
  • Complete bottom portion, sign, and date
primary health care phc46
Primary Health Care (PHC)

Quarterly FSR 269a Report Submission

  • Table is in the Manual Section 2 page 2
  • Due Dec 31, Mar 31, June 30, and Nov 30
  • Original signatures required
  • Mail two separately to: DSHS

CPU mail code 1940 and CMB mail code 1914

1100 W. 49th St Austin, TX 78756

primary health care phc47
Primary Health Care (PHC)

Common Errors on the FSR 269a

  • Incomplete, or inaccurate Identifying Data
  • Incorrect approved budget
  • Expenditures and income don’t match the MRR
  • DSHS share exceeds the contract amount
  • Reimbursements don’t include expected amounts
primary health care phc48
Primary Health Care (PHC)

Annual PHC 300 Tips

  • #1-#2 totals should tie with question # 5 on the August PHC 200
  • #3 totals for both race and ethnicity should each tie with #1-#2
  • #4 totals should add to equal #1-#3
primary health care phc49
Primary Health Care (PHC)

Annual PHC 300 Tips (continued)

  • #5-#7 totals should all be the same and only include individuals 18 and older
  • #8 subtotals for B should be the sum of B and A + B should equal #1
  • #9 individuals may be counted for multiple scenarios and the total should be no less than #1
  • #10 list the number of counties served even if not on your SDP and the total clients should equal #1
primary health care phc50
Primary Health Care (PHC)

Annual PHC 300 Tips (continued)

  • #11individuals may be counted for multiple scenarios and the total should be no less than #1
  • Narrative Progress Outcome

A. Service Delivery Plan Outcome

B. FQHC Coordination

C. Medicare Prescription Drug Card/Medicare Part D

D. Program Narrative - Optional

primary health care phc51
Primary Health Care (PHC)

Submitting the Annual PHC 300

  • Table is in the Manual Section 2 page 2
  • Due via fax to CMB at 512-458-7532
  • Due November 30
primary health care phc52
Primary Health Care (PHC)

Contacts

  • Deborah Lewis 512-458-7781 Program review questions
  • Grisilda Porter 512-458-7111 ext 2940 Payment status questions
  • Millicent Wilkins 512-458-7111 ext 2285 Vendor ID questions
  • Gina Baber 512-458-7111ext 6445 Contract Amendment questions
  • Kim Roberts 512-458-7111 ext 2990 Policy questions
primary health care phc53
Primary Health Care (PHC)

Questions & Answers

  • Making the pieces fit
breast cervical cancer control bccc
Breast & Cervical Cancer Control (BCCC)
  • Accessing Procedures Manual
  • Forms and Instructions
  • Submitting Reports
  • Report Approvals
  • Common Questions
  • Common Errors
  • Contacts
breast cervical cancer control bccc55
Breast & Cervical Cancer Control (BCCC)

Accessing Policy & Procedure Manual

http://www.dshs.state.tx.us/bcccs/contractonly.shtm - manual

Manual of Operations (MOO)

Standard IX page 29

breast cervical cancer control bccc56
Breast & Cervical Cancer Control (BCCC)

Forms and Instructions

  • Form #B-13, State of Texas Purchase Voucher
  • http://www.dshs.state. tx.us/grants/forms.shtm
  • Identifying information found on cover pages 1 & 2 of the contract
  • July and August must be billed separately
breast cervical cancer control bccc57
Breast & Cervical Cancer Control (BCCC)

Forms and Instructions (continued)

  • Enter the date the voucher is submitted in box 6
  • Enter the 14 digit payee identification # in box 9
  • Enter correct purchase order number in box 12
  • Make sure the Document amount in box 13 matches the total reimbursement requested
  • Enter payee name and address in box 14
  • Enter the service delivery date in box 19
breast cervical cancer control bccc58
Breast & Cervical Cancer Control (BCCC)

Forms and Instructions (continued)

Description of Goods or Services box 20

  • Include statement for reimbursement
  • Program is CHS/BC
  • Contract Term is 07/01/06 – 06/31/06
  • 10-11 character document #
  • Year and 2-3 character attachment
  • Program code is 274
breast cervical cancer control bccc59
Breast & Cervical Cancer Control (BCCC)

Forms and Instructions (box 20 continued)

Include the following:

  • Clinical Services
  • Support Fees (up to 10% of clinical services)
  • Case management
  • Professional Education Travel

All of these must be itemized with amounts even if there is no billing

breast cervical cancer control bccc60
Breast & Cervical Cancer Control (BCCC)

Forms and Instructions (continued)

  • Boxes 21 & 22 can be omitted for BCCC
  • Put all 4 amounts & the total in box 23
  • Put the contact name and phone # in box 24
  • All remaining boxes should be left blank
  • Please do not sign the approval box
breast cervical cancer control bccc61
Breast & Cervical Cancer Control (BCCC)

Forms and Instructions (continued)

  • BCCC Summary (Sum) Billing Form
  • This form must be attached to the State of Texas Purchase Voucher (B-13)
breast cervical cancer control bccc62
Breast & Cervical Cancer Control (BCCC)

Forms and Instructions (Sum form continued)

  • Enter contractor number
  • Enter billing month
  • Enter contractor name
  • Enter award amount
  • Enter CD client identification number
  • Enter CPT procedure code
  • Enter date of procedure
  • Enter billing amount from BCCC Budget Table found in the contract Exhibit A
breast cervical cancer control bccc63
Breast & Cervical Cancer Control (BCCC)

Submitting Monthly Reports

  • Due 30 days following the end of the month
  • B-13 & Sum form emailed to the Central Processing Unit (CPU) at invoices@dshs.state.tx.us, or faxed to 512-458-7442
  • B-13 & Sum form faxed to 512-458-7235
  • Please submit all pages simultaneously
  • Only submit revised pages when corrections are requested
breast cervical cancer control bccc64
Breast & Cervical Cancer Control (BCCC)

Report Approvals

  • Review B-13 for completeness and accuracy
  • Review Sum detail for completeness and accuracy
  • Notify provider if mistakes are found and resolve issues
  • Sign & copy voucher when approved
  • Enter data on spreadsheet
  • Take sign copy to the Central Processing Unit
breast cervical cancer control bccc65
Breast & Cervical Cancer Control (BCCC)

Common Errors

  • Purchase order # not included in box 12
  • Incorrect purchase order number & other identifying information
  • Dates incorrect
  • Itemized amounts omitted
  • Totals incorrect
  • Rates incorrect
breast cervical cancer control bccc66
Breast & Cervical Cancer Control (BCCC)

Common Questions

Q. Can you bill more than one month on the same billing?

  • Yes as long as service dates are clear.

Q. Can you bill a procedure at different rate than the BCCCS rate schedule?

  • No.

Q. Can you bill a CPT code that is not listed on the rate schedule?

  • No.
breast cervical cancer control bccc67
Breast & Cervical Cancer Control (BCCC)

Common Questions (continued)

Q. How is the support fee calculated?

  • It is 10% of clinical services not including Case Management Fee for Service

Q. Can you bill the new budget for services provided in the previous year?

A. No.

breast cervical cancer control bccc68
Breast & Cervical Cancer Control (BCCC)

Quarterly Matching Contribution Report

  • Due Oct 31, Jan 31, Apr 30, and Jul 31
  • Requirement $3 Federal to $1 State match
  • Contracts report proposed match in funding application
breast cervical cancer control bccc69
Breast & Cervical Cancer Control (BCCC)

Quarterly Matching Contribution Report Instructions

  • Contractor name as it appears on contract
  • Indicate current budget period
  • Indicate reporting quarter
  • Indicate the base award
  • Indicate projected match
breast cervical cancer control bccc70
Breast & Cervical Cancer Control (BCCC)

Quarterly Matching Contribution Report Instructions (continued)

If additional funding are received,

  • Indicate additional funding award
  • Indicate match for additional funding

If additional funding is not received.

  • Indicate N/A in for additional funding & match
breast cervical cancer control bccc71
Breast & Cervical Cancer Control (BCCC)

Quarterly Matching Contribution Report Instructions (continued)

  • Indicate Total Award
  • Indicate Total Match
  • Indicate the date the report was submitted
  • Indicate the name of the person submitting the report
  • The name at the bottom must be the person who is authorized to verify match information
breast cervical cancer control bccc72
Breast & Cervical Cancer Control (BCCC)

Quarterly Matching Contribution Report Instructions (continued)

For each category (type of service) list the following:

  • Detailed description of the service provided
  • Non-federal funding source
  • Quarterly amounts
  • Cumulative totals
breast cervical cancer control bccc73
Breast & Cervical Cancer Control (BCCC)

Annual DSHS Form GC-10 (270)

  • PDF File
  • http://www.dshs.state.tx.us/grants/forms.shtm
  • Revisions still need to be addressed
  • This form should be used in the interim
breast cervical cancer control bccc74
Breast & Cervical Cancer Control (BCCC)

Annual Report Submission

  • Due no later than 90 days after the end of the contract term
  • Original signatures required
  • Mail two separately to: DSHS

CPU mail code 1940 and CMB mail code 1914

1100 W. 49th St Austin, TX 78756

breast cervical cancer control bccc75
Breast & Cervical Cancer Control (BCCC)

Contacts

  • Vince Crawley 512-458-7111 ext 6467 Program review questions
  • Mitra Kookma 512-458-7111 ext 2085 Payment status questions
  • Millicent Wilkins 512-458-7111 ext 2285 Vendor ID questions
  • Gina Baber 512-458-7111ext 6445 Contract Amendment questions
  • Isa Covio 512-458-7111 ext 2792 Policy questions
breast cervical cancer control bccc76
Breast & Cervical Cancer Control (BCCC)

Questions & Answers

  • Making the pieces fit